Hiv administration protocols

ABSTRACT

Administration protocols for a fusion protein, matrix protein and psoralen inactivated HIV based immunogenic composition that induces an immune response to HIV. The immunogenic compositions are based on HIV biologically active fusion peptide, matrix peptide, or psoralen inactivated HIV. The number of doses is 3X. The starting dose for an adult is 1×10 9 -1×10 10  . The starting dose for an adolescent is ½(1×10 9 -1×10 10 ). The starting dose for a pediatric patient is ¼(1×10 9 -1×10 10 ). The second dose will consist of 1/10 th  of starting concentrations. The third dose will consist of 1/100 th  of starting concentrations. This will facilitate a Th-1 response. The days of administration are days 1; 30; and 180. Alternatively the days of administration are days 1; 20-40; and 160-200. The site of administration is one that targets lymphatic tissue. Adjuvant is administered before, simultaneous with or after each dose of the immunogenic compositions. Adjuvants are used to promote a Th-1 immune response and include a leukotriene receptor antagonist such as Montelukast, a mast cell and basophil stabilizer such as Cromolyn, and a prostaglandin synthetase inhibitor such as Indomethacin. Th-1 immune responses to the immunogenic compositions are monitored. The 3X cycle will repeat on until a Th-1 immune response is observed. At that point, the immunogenic composition administered could then decline by a factor of 10 for two more vaccination procedures.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional Application Ser. No. 61/195,541 filed Oct. 8, 2008 which is related to U.S. Non-Provisional application Ser. No. 10/971,426 filed Oct. 22, 2004 which claims priority to U.S. Provisional Application Ser. No. 60/513,827 filed Oct. 23, 2003, which are hereby incorporated in their entirety by reference; the present application claims priority to U.S. Provisional Application Ser. No. 61/195,540 filed Oct. 8, 2008 which is related to U.S. Non-Provisional application Ser. No. 10/971,445 filed Oct. 22, 2004 which claims priority to U.S. Provisional Application Ser. No. 60/513,827 filed Oct. 23, 2003, which are hereby incorporated in their entirety by reference; the present application claims priority to U.S. Provisional Application Ser. No. 61/195,539 filed Oct. 8, 2008 which is related to U.S. Non-Provisional application Ser. No. 10/971,229 filed Oct. 22, 2004 which claims priority to U.S. Provisional Application Ser. No. 60/513,827 filed Oct. 23, 2003, which are hereby incorporated in their entirety by reference; and the present application claims priority to U.S. Provisional Application Ser. No. 61/195,526 filed Nov. 5, 2008 which is related to U.S. Non-Provisional application Ser. No. 10/971,445 filed Oct. 22, 2004 which claims priority to U.S. Provisional Application Ser. No. 60/513,827 filed Oct. 23, 2003, which are herby incorporated in their entirety by reference.

FIELD OF THE INVENTION

This invention relates to the field of virology and immunology. An aspect of the invention relates to methods of administration of an immunogenic composition based on an HIV fusion protein, and HIV matrix protein, or psoralen inactivated HIV.

BACKGROUND OF THE INVENTION

Despite profound efforts, there is no curative vaccine for HIV. Various steps of the HIV life cycle have been targeted by inventors. To date, research has not found a composition that will foster an effective immune response against the immunosuppressive retrovirus HIV-1. As disclosed in related U.S. patent application Ser. No. 10/971,426, HIV fusion protein serves as a basis of an immunogenic composition against HIV. As disclosed in related U.S. patent application Ser. No. 10/971,229 HIV an HIV-1 matrix polypeptide myristate binding site (amino acid sequence, GARASVLSSGG) or corresponding nucleic sequence serves as a basis of an immunogenic composition capable of selectively eliciting a substantially Th-1 immune response to HIV-1. As disclosed in related U.S. patent application Ser. No. 10/971,445, psoralen inactivated HIV serves as a basis of an immunogenic composition against HIV. An embodiment of the present invention further contemplates specific administration protocols for the HIV fusion protein, matrix protein and psoralen inactivated HIV based immunogenic compositions.

SUMMARY OF INVENTION

An aspect of the invention relates to methods of administration of an immunogenic composition based on an HIV fusion protein, matrix protein and psoralen inactivated HIV. The immunogenic compositions are based on HIV biologically active fusion peptide, matrix peptide, or psoralen inactivated HW. The number of doses is 3X. The starting dose for an adult is 1×10⁹-1×10¹⁰. The starting dose for an adolescent is ½ (1×10⁹-1×10¹⁰). The starting dose for a pediatric patient is ¼ (1×10⁹-1×10¹⁰). The second dose will consist of 1/10^(th) of starting concentrations. The third dose will consist of 1/100^(th) of starting concentrations. This will facilitate a Th-1 response. The days of administration are days 1; 30; and 180. Alternatively the days of administration are days 1; 20-40; and 160-200. The site of administration is one that targets lymphatic tissue. Adjuvant is administered before, simultaneous with or after each dose of the immunogenic compositions. Adjuvants are used to promote a Th-1 immune response and include a leukotriene receptor antagonist such as Montelukast, a mast cell and basophil stabilizer such as Cromolyn, and a prostaglandin synthetase inhibitor such as Indomethacin. Th-1 immune responses to the immunogenic compositions are monitored. The 3X cycle will repeat on until a Th-1 immune response is observed. At that point, the immunogenic composition administered could then decline by a factor of 10 for two more vaccination procedures.

BRIEF DESCRIPTION OF FIGURES

FIG. 1 is a flowchart for fusion protein and matrix protein synthesis, purification, and assessment of biological activity.

FIG. 2 is a flowchart of an administration and dosing regimen of an immunogenic composition based on HIV fusion protein, matrix protein or psoralen inactivated HIV.

DESCRIPTION OF THE INVENTION

The smallest amount of antigen that elicits an immune response is most likely to facilitate a Th-1 response. The minimal amount of antigen administered can be a starting point for all vaccine recipients. Ideally, all would have no response to the initial dose. Subsequent vaccinations would consist of a ten-fold increase in biologically active antigen. This would continue on until an immune response is noted in follow-up laboratory procedures. At that point, the vaccine administered would then decline by a factor of 10 for two more vaccination procedures.

In one embodiment, the dose of antigen required to elicit the initial response may be the same, or close to the same, for all participants. In another embodiment, the dose of antigen required to elicit the initial response may be different for participants. In another embodiment, variations of this procedural protocol may be streamlined and/or altered by those of ordinary skill in the art for this type as well as follow-up studies.

Sample Protocol I:

Cloning the DNA Encoding the Fusion Protein and Matrix Protein

A variety of DNA technologies allowing the investigator to construct and replicate recombinant DNA molecules after transfer of the recombinant nucleic acid into a host cell, prokaryotic or eukaryotic have been defined in the literature. Characteristically, the bacterium E. coli also known as K12 has been the defining gold standard for prokaryotic recombinatory DNA vector systems. Yeast such as Saccharomyces cerevisiae has been utilized as a host cell for the cloning as well as the expression of viral and eukaryotic genes. Yeast artificial chromosomes have been developed which are able to clone fairly large sizes of DNA. Gene transfer into plant cells can be accomplished by bacterial plasmid vectors. The bacterium Agrobacterium tumifaciens for gene transfer into plants is also well defined. Viral DNA can also be transferred into mammalian cells in vitro which can be used as a source for clone DNA. Methods of DNA transfer include endocytosis, liposomes, plasmids and gene gun technology. Retroviral vectors have also been utilized to insert foreign DNA into a targeted host mammalian cell. PCR will allow in vitro amplification of any defined DNA segment.

The intact HIV virion or defined structural protein derived from the HIV virion can be a source of the fusion protein and matrix protein. The HIV virion can be derived from an HIV positive patient or an in vitro cell culture or other procedures known in the art.

Assessment of Biological Activity of the Fusion Protein

The fusion protein mediates the fusion of the viral and targeted cell plasma membrane. Disruption of the targeted cell membrane can be noted by changes in the UV absorption spectrum of the targeted plasma membrane. The molecular weight of the fusion protein has been defined. Therefore, the number of individual fusion proteins can be determined by measuring the weight of the targeted immunogen. Total weight of the targeted immunogen divided by the molecular weight of the fusion protein will yield the number of individual fusion proteins (X).

The number of cells (Y) in a target medium can also be accurately estimated by a variety of technologies currently available to the cell physiologist. Monoclonal antibodies to the fusion protein can be produced or are available commercially. A specified number of fusion peptides (X) can be added to a cell culture consisting of (Y) number of viable cells. The number of cells and/or percentage of cells with a disrupted plasma membrane can be documented by changes in UV absorption of the plasma membrane.

As a control, fusion peptides bound to monoclonal antibodies will be added to an identical cell culture. The control should demonstrate minimally, if any, plasma membrane disruption. The test vehicle containing fusion peptides unbound to monoclonal antibodies will yield a certain number or percentage of penetrated/disrupted plasma membranes. The number or percent of plasma membranes disrupted by the control should be subtracted from the actual test vehicle (if the control is done appropriately, this number will approach zero). This will give a reproducible, standard, biological assay of fusion protein function which can be given a specific value. Using the standardized cell culture, the biological activity of a fusion protein derived from any source can be determined and quantified.

In a cell culture of Y number of cells in which a specified number of fusion peptides (X) has been added, a number of cells (A) will have a disrupted plasma membrane and a number of cells (B) will have an intact plasma membrane. Y=A+B.

After addition of the fusion peptide, a number of ratios can be used to assess biological activity. In one embodiment, the ratio is A/Y. Other ratios such as B/Y or A/B or B/A can also be used.

In one embodiment, the A/Y ratio employed as a measure of biological activity may be 0.5 or greater. This ratio will allow for accurate assessment of the functional immunogenicity of the compound at its time of manufacture. Stability of the product can also be assessed periodically and just prior to administration.

Assessment of Biological Activity of the Matrix Protein

The matrix protein must undergo N terminal myristoylation on the N terminal glycine residue. The enzyme accomplishing this, N-myristoyl transferase (NMT) is a monomeric enzyme catalyzing transfer of myristate from myristoyl-CoA to a targeted peptide.

The amino acid sequence, GARASVLSSGG, of the matrix protein and its molecular weight has been defined. The weight of a pure composition of matrix protein can be determined. Divided by the molecular weight of the matrix protein, the number of matrix peptides can be determined.

Biological activity of the matrix protein will be dependent upon its ability to undergo N terminal myristoylation and its subsequent ability to attach to a targeted cell plasma membrane.

A defined quantity of unprocessed matrix proteins (X) can undergo N terminal myristoylation with a defined number of NMT enzymes (Y) to yield the matrix protein with an N terminal myristoyl moiety. Differences in the sedimentation coefficients of the myristoylated matrix protein (A) and the non-myristoylated protein (B) will allow easy separation of the two molecules. The molecular weight of the myristoylated matrix protein has been determined and this will facilitate quantification of the number of matrix proteins (A) that were bound to myristate by NMT at the N terminal glycine residue and the number of matrix proteins that were not bound to myristate (B). X=A+B.

The first measure of biological activity is the capacity of the immunogen to covalently bond myristate. Multiple ratios can be used. In one embodiment A/X is used. Other ratios include B/X, A/B and B/A.

The myristoylated matrix proteins (A) are then added to an in vitro erythrocyte cell culture. Erythrocytes do not have a nucleus and therefore are not capable of replication and have a long half life of approximately ninety days. An accurate estimate of the number of erythrocytes (C) in a cell culture can be defined by a cell physiologist by a number of technologies currently employed. This number will stay constant over the duration of this procedure since the time sequence of this procedure will be measured in minutes or hours, not days or weeks. After a short incubation period (in one embodiment—approximately thirty minutes) the red blood cells will be separated from the unbound myristoylated matrix proteins (D) by centrifugation. The total number of myristoylated matrix proteins (A) equals the number of bound (E) and unbound myristoylated matrix proteins (D). Therefore A=D+E.

Numerous ratios can be utilized to assess this stage of biological activity. In one embodiment E/A is used. In one embodiment, the final calculation of biological activity will be A/X×E/A.

A defined measure of biological activity will serve multiple functions. For example, before a vector can be considered a part of an immunogen composition, it must have the biological activity of at least 0.5. To assess stability of the immunogen, the biological activity can be reassessed at various times. Significant decline of more than 5% of the original number would result in elimination of that immunogen composition from use.

The fusion protein and matrix protein synthesis, purification, and assessment of biological activity are illustrated in FIG. 2 in a flowchart.

Sample Protocol II for Psoralen Inactivated HIV Based Immunogen

In one embodiment, the first dose of psoralen vaccine may consist of a solution and/or suspension and/or lyophilized whole inactivated HIV-1 and/or HIV-2 virions. Lyophilization is the creation of a stable preparation of a biological substance by rapid freezing and dehydration of the frozen product under high vacuum, also known as freeze drying whole inactivated HIV-1 and/or HIV-2 virions.

Two sources of HIV virions exist: 1) HIV positive patients, and 2) in vitro cell cultures of HIV. The advantage of the first is the structural and genetic integrity of the virion that has not been comprised by passage through in vitro cell lines. The disadvantage of the first is the possibility of contaminating substances, including other pathogens, HIV derived proteins, host derived proteins, carbohydrates, lipids and nucleic acids of immune and non-immune origin, and anti-microbial elements taken by the host. It is anticipated that all pathogens will be rendered replication incompetent by the psoralen/UV light protocol. An inactivated immunogen, however, can have an immune modulating function that may or may not be beneficial. Since the virus continues to mutate ad infinitum within the host, a lack of homogeneity compromising (theoretically) the ability to reproduce the study will characterize this source of HIV virions. Furthermore, viral proteins such as Tat, Rev, Nef and gp 120 will contaminate the specimen if not properly removed. Methods to separate intact virions from viral proteins do exist, but are not 100% full proof. The above-mentioned contaminated proteins immune suppress the HIV patient and therefore, would likely immune suppress the patient.

Utilizing the second method, the virus will be cultivated and isolated from in vitro cell cultures of stock HIV strains and circulating recombinant forms that have been identified, characterized and sequenced. The genetic content and corresponding protein structure of the whole HIV virion and component parts are published and readily available through multiple sources. Passage of these HIV virions through continuous or non-continuous cell cultures facilitates continual HIV mutation. Therefore, this source of HIV will also be compromised by a lack of homogeneity compromising reproducibility of the study.

A virus is not a homogenous composite of individual replication competent particles. The viral structures are assembled following the same rules of chemistry, physics and math that snowflakes must follow. Therefore, it would be impossible to attain homogeneity of strain of any virus derived from a host animal, cell culture or animal model of that disease. Validation of this concept is found in the Salk and Sabin polio vaccines. Both used in vitro cell cultures of RNA viruses that replicate like HIV at or near the error threshold. Both vaccines, however, were successful, even though one can logically conclude that the virions employed in their vaccination protocols were not mere images of the in vivo viruses afflicting mankind.

Regardless of source, the HIV virions will be photosensitized with one or more psoralens (furocoumarins) and then exposed to ultraviolet A (UVA radiation 320 to 400 nm). Crosslinks and monoadducts of the viral nucleic acids will result effectively eliminating all replication competence.

Following Koch's postulates, any animal with a disease has to be shown to be infected by a specific microorganism. In this situation, the infected “animal” will be the cell culture. It also must be shown that any animal without this microorganism does not have the disease. The infecting organism has to be isolated from the infected animal (in this circumstance the cell culture) and then upon inoculation into another animal (once again in this circumstance the cell culture) infect, replicate and inflict pathogen derived histopathologic changes consistent with the disease under study. Isolation of the pathogen from the second animal (or cell culture in this circumstance) must also be followed by successful tissue cultivation. In this circumstance, after the virus is grown in cell culture, photosensitized with psoralen, exposed to the appropriate wave length and duration of UVA, they must demonstrate no replication competence upon introduction into another cell culture identical to and/or derived from the initial cell culture from which the HIV virions were harvested. This will assure replication incompetence of the immunogen.

Isolation and expansion of HIV, in vitro, can be readily accomplished. Classically, leukocyte enriched whole blood from an HIV negative patient, also known as leukopacks or buffy coats, serve as tissue culture medium. Leukopacks are available from local blood banks.¹ Mass quantification of cell-associated HIV derived virions can be accomplished by the appearance of the p24 gag protein in the culture supernatant.² Quantification of cell-free HIV virions can be accomplished by reverse transcriptase activity.³ Identification of the isolate can be facilitated by determination of syncytium-inducing (SI) isolates versus nonsyncytium-inducing (NSI) phenotypes of HIV can be accomplished using MT-2 cells.⁴ Further refinement of virion identification can be accomplished by assessing chemokine coreceptor tropism of the HW virions using transduced human osteosarcoma (HOS) cells.⁵ ¹Nelson Michael, et al., 1999, HIV Protocols, Chapter 1, pp. 3-10.²Nelson Michael, et al., 1999, HIV Protocols, Chapter 2, pp. 11-15.³Nelson Michael, et al., 1999, HIV Protocols, Chapter 3, pp. 17-22.⁴Nelson Michael, et al., 1999, HIV Protocols, Chapter 4, pp. 23-27.⁵Nelson Michael, et al., 1999, HIV Protocols, Chapter 5, pp. 29-33.

Sterility must be assessed and this may be accomplished by incubating the sample, or portion thereof, on a solid or liquid medium for 24-48 hours at 37° C.

Purity may be assessed and accomplished by cesium chloride⁶, ultra centrifugation⁷, airfuge ultra centrifugation⁸, gel electrophoresis⁹ and electroelution¹⁰. Monoclonal antibodies may be used identify and separate the vaccine targeted HIV virions by binding to a specific envelope epitope that is not immunologically cloaked or hidden by tertiary folding and/or glycosylation and is a unique structure found only on this one strain of HIV that is cultivated in the cell culture. This epitope is not found on other wild type or in vitro cell culture derived HIV strains. This will identify the protein fingerprint of the cultivated virus. Structure of the HIV virions can be assessed by infrared and nuclear magnetic resonance as well as mass, ultraviolet and electron spin resonance. Other methods of identifying virion structure, mass, ultraviolet and electron spin can be employed to assure virion identity and (relative) homogeneity. All contaminants of the manufacturing process should be removed. ⁶Botho Bowien, et al., 2003, Nucleic Acids Isolation Methods, Chapter 2, pp. 7-19.⁷Steven Specter, et al., 2000, Clinical Virology Manual, Third Edition, Chapter 5, pp. 54-65.⁸Steven Specter, et al., 2000, Clinical Virology Manual, Third Edition, Chapter 5, pp. 54-65.⁹Botho Bowien, et al., 2003, Nucleic Acids Isolation Methods, Chapter 7, pp. 81-93.¹⁰Botho Bowien, et al., 2003, Nucleic Acids Isolation Methods, Chapter 7, pp. 81-93.

Potency may be quantitatively and qualitatively assessed by the capacity of the immunogen to elicit a Th-1 biased immune response in an animal model to the immunogen itself and not a cross-reacting substance.

The bulk quantification of the HIV virions may be deduced by reverse transcriptase activity. The immunogen may then be evenly divided into a defined number of vaccination lots or bottles and properly labeled as far as name, diluent (if applicable), amount of active component per volume, storage instructions, caution notification, site of manufacture, auspices under which the vaccine was prepared, lot designation, control and vial number. In one embodiment, storage conditions, such as temperature and light, may be well defined on the label. Adjuvants, preservatives and included antibiotics, may also be labeled on the vial. Each vial will have temperature sensitive paper attached to it which will change color if the vial has been exposed to temperatures too high or too low.

A standardized DNA fingerprint from the stock HIV virus will be determined and serve as a guide to assess mutation and/or lack thereof in subsequent cell cultures. Prior to the addition of psoralen and exposure to UVA, the RNA from the HIV virions of each cell culture will undergo in vitro reverse transcription into its complimentary DNA and compared to the standardized line. Any significant deviation will be documented and those HIV virions will not be included in the vaccine.

In one embodiment, each vial will also be labeled with date and place of manufacture, expiration date and itinerary (chain of custody), including sites of transport and storage and conditions therein, including temperature and light exposure.

Most importantly, however, is the ability of the inactivated virion to assume the role of a replication competent virion in at least part of the HIV virion life cycle. Only upon doing so will the immunogen be recognizable as foreign and elicit an immunogenic response. The psoralen/UVA inactivated virions must maintain the capability to attach to a target cell and undergo fusion with the target cell plasma membrane. All immunogenic compositions of whole inactivated virions should be subjected to regular in vitro testing, preferably with peripheral blood mononuclear cells from HW negative donors. The ability to attach to and be assimilated into the target cell stands testimony to the structural and functional integrity of the immunogen.

The biological activity of the immunogen can be quantified by a variety of ratios based upon a simple arithmetic equation: total number of virions (TV) equal number of free unattached virions (FV) plus the number of attached virions (AV) noted in an in vitro peripheral blood mononuclear cell culture derived from an HIV negative patient.

TV=FV+AV. TV can be calculated with knowledge of the average molecular weight (AMW) of an HW virion. The weight of a pure or near pure HIV immunogen (WHI) source can be determined. WHI/AMW=TV. Monoclonal antibodies can be utilized to separate out the unattached virions (FV) from the attached virions (AV) and quantify directly FV and indirectly AV. Well-defined calcium fluxes will occur upon virion binding. A multiplicity of methods exists to separate metabolically active from inactive T and B cells. This would serve to define AV directly.

Therefore, the biological activity of the psoralen immunogen can be determined directly and indirectly from the above equations. Preferably, the immunogen will have an AV/TV ratio of 0.8 or greater. Other ratios may be used.

Samples of every lot dispensed for human use, animal model use, in vitro experimentation and cell culture may be preserved in glycerol and placed under dry ice (solid CO₂) conditions at −70° C. in perpetuity.

Sample Protocol III

Patient Selection—Exclusion criteria:

1. Active infection either acute or chronic (a trial involving only HIV patients can be performed, but must be separate from those that are HIV negative)

2. Any auto-immune disorder, including eczema and psoriasis

3. Malnourished patients, including anorexia, bulimia, kwashiorkor, vitamin or mineral deficiencies

4. Active malignancy or history of malignancy

5. Prior participation in any drug or vaccine trial

6. Prior significant irradiation exposure

7. Any immunosuppressive diseases

8. Chronic use of any prescribed medication

9. Mastocytosis

10. Carcinoid

11. Psychiatric disturbances

12. Patients with undefined prior medical history

13. Asthma

14. History of drug sensitivities

15. Addison's disease

16. Crohn's disease

17. Hypothyroidism

18. Hyperthyroidism

19. Hypoparathyroidism

20. Hyperparathyroidism

21. Pregnancy or possibility occurring during course of the trial. All women of child bearing potential who wish to participate in the trial must either be celibate or use a reliable, definable method of birth control that is documented by a member of the research team.

22. Growth hormone deficiency or acromegaly.

23. Diabetes mellitus

24. Diabetes insipidus

25. Asplenic patients

26. Sickle cell disease

27. Any hemoglobinopathy

28. Any organ disease, including cardiac, hepatic, renal, intestinal, etc.

29. Patients planning on travelling out of range of the treatment facility

30. People involved in administering this program or families thereof

31. Prior history of STDs

32. Down syndrome or other chromosomal aberrations

33. Multiple dystrophy or other genetic disorders

34. Eosinophilia and/or increase in basophils found in whole blood

Patient Selection—Inclusion Criteria

1. Must understand and agree to all aspects of the Informed Consent

2. Age 2-30 at time of protocol commencement. Ideal age 16-18.

3. Must not have any exclusion criteria

4. Must be available at all planned intervention times and be willing to meet at other times PRN

5. Must be willing to document and share any and all possible adverse reactions

6. Must be willing to document and share information on all sexual contacts before and after trial. All sexual contacts must be tested for all forms of STDs

7. PPD negative

8. Have positive responses to control recall antigen influenza virus (demonstrates intact Th-1 immune repertoire)

9. Have positive responses to control recall tetanus toxoid (demonstrates intact Th-2 immune repertoire)

10. Must be ambulatory

Method of Vaccination

Intradermally or orally.

Preferred Site of intradermal vaccination.

Upper medial thigh (clothed area, non-UV irradiated) drains into Peyer's patches

Vaccine Site Preparation

Shave area to be vaccinated approximately 24 hours before vaccine administration. This will stimulate the skin to become a tertiary lymphatic tissue facilitating vaccine assimilation and processing. Just prior to vaccine administration, a blood pressure cuff over the proximal thigh inflated to approximately 20 mm of mercury for 20 minutes (increases venous pressure which leads to increased lymphatic flow). Just prior to and after vaccine administration, site should be warmed and exercised.

Caring for Vaccination Site After Administration

Patient prohibited from bathing or cleansing the site or to go swimming for 12 hours

Exclusion Criteria of Vaccine Site

Recent skin lacerations, breaks, contusions or bruising

Active skin infection: bacteria, fungus, Candida, virus (warts)

Timing of Vaccinations

Day 1, 30, and 180. Alternatively, Day 1, 20-40, and 160-200

Adjuvants

An adjuvant is administered before, simultaneous with or after each dose of the immunogenic compositions. Adjuvants are used to promote a Th-1 and include a leukotriene receptor antagonist such as Montelukast, a mast cell and basophil stabilizer such as Cromolyn, and prostaglandin synthetase inhibitors such as Indomethacin.

Specific Additional Lab Tests to be Performed on All Participants

IgG₁, IgG₂, IgG₃, IgG₄ titers to the subunit vectors (IgG₁ and IgG₃ facilitate a Th-1 response and IgG₂ and IgG₄ facilitate a Th-2 response), as well as IgA, IgM and IgE titers to the subunit vectors. IgM is indicative of an acute immunologic response to a pathogen or pathogen-derived protein in an immunologically naive patient (no prior immune response to the specific pathogen or pathogen epitope). IgE would be indicative of an allergic, Th-2 mediated immunologic response. IgA would, in most circumstances, be consistent with a Th-2 response.

Conduct qualitative and quantitative cytotoxic T cell assays to the subunit vectors according to standardized procedures known in the art.

Dates Tests to be Performed

Testing will be done immediately prior (approximately one week) to each vaccine administration. Any response consistent with a Th-2 bias would eliminate that patient from further trial participation.

Sample Protocol IV:

Dosing of Vaccines

Targeting dose for an adult (age >16) male or female will contain between 1×10⁹ and 1×10¹⁰ HIV biologically active fusion peptides. The second dosage will be 1/10^(th) of the initial vaccination. The third dosage will be 1/100^(th) of the initial vaccination. Adolescent patients from age 8-15 would receive one-half (½) of the above doses. Pediatric patients would receive one-fourth (¼) of the above dosing schedule.

In one embodiment a first vaccine will consist of X concentration of HIV-1 fusion or matrix protein polypeptide or Y concentration of the corresponding nucleic acid sequence combined with a pharmaceutically acceptable carrier. The precise dosing will depend upon the patient's age, weight, and gender. The second vaccine will consist of 1/10^(th) of both X and Y concentrations. The third vaccine will consist of 1/100^(th) of X and Y concentrations. This will facilitate a Th-1 response.

In one embodiment for administration of psoralen inactivated HIV, the first vaccine will consist of [X] concentration of an ultraviolet radiation and psoralen inactivated HIV virus combined with a pharmaceutically acceptable carrier. The precise dosing would depend upon the patient's age, weight and gender. The second vaccine will consist of 1/10^(th) of [X] concentration. The third vaccine will consist of 1/100^(th) of [X] concentration. This will facilitate a Th-1 response.

With each administration protocol, Th-1 immune responses to the immunogenic compositions are monitored. The 3X cycle will repeat until a Th-1 immune response is observed. At that point, the immunogenic composition administered would then decline by a factor of 10 for two more vaccination procedures.

The purpose of eliciting an immunologic response is to cultivate memory cells specific for the immunogen(s). With each vaccine administration, memory cells are activated. Memory cells require smaller amounts of antigen to proliferate than naive inactivated T cells. Therefore, subsequent follow-up vaccination efforts require fewer antigens than the initial vaccination. Also, the basic concept that the least amount of antigen with the shortest half-life is most likely to elicit a Th-1 response holds true with initial exposure to the immunogen as well as subsequent re-exposures.

The above administration and dosing regimen of an immunogenic composition based on HIV fusion protein, matrix protein or psoralen inactivated HIV are illustrated in FIG. 2 in a flowchart.

Sample Protocol V:

In one embodiment, lymphatic targeting of the vaccine may be selected. Lymphatic tissue is a site of over 90% of all white blood cells. The turbulence within the arterial arm of the vascular system created by the high pressure is not conducive for immune function. The low pressure within the venous system is still not optimal for activation and functions of white blood cells and complement proteins, due to high flow velocity. Within the lymphatic tissue, not only is the pressure low, but the flow velocity is minimal. Approximately 3 liters of fluid percolate through the left thoracic duct per day and 1 liter through the right thoracic duct. Inserting a plastic cannula into a lymphatic vessel on the dorsal surface of the foot, as well as elsewhere on the lower extremity, can be accomplished for vaccine administration. This is a tedious, time consuming and somewhat uncomfortable procedure, and requires a skillful, competent, conscientious technician.

Sample Protocol VI:

In one embodiment, after proper patient selection, patient preparation commences. To enhance a Th-1 response, the patient should receive, for one month, the following medications: (1) Montelukast, (2) Cromolyn, and (3) Indomethacin. Indomethacin is a prostaglandin synthetase inhibitor. Montelukast is a leukotriene blocker and Cromolyn stabilizes mast cells and basophils. Leukotrienes mediate inflammatory, Th-2 responses. Mast cells and basophils facilitate Th-2/allergic responses. Prostaglandins are implicated in the inflammatory response that characterizes a Th-2 response. In the Th-1 versus Th-2 paradigm, a see-saw can be envisioned. By dampening the Th-2 response, the Th-1 response will be enhanced.

Sample Protocol VII:

Louis Pasteur created the second vaccine for human use. It was predominantly used to prevent the development of rabies after exposure. Initially, he administered a replication incompetent “dead vector.” The vaccine was administered daily for approximately two weeks. Viability of the virus was temporized in vitro. After administration of the dead vector, he administered weakened but replication competent virus to the recipient. Finally, on the last day of the series of vaccines, he administered live replication competent non-attenuated rabies virus.

It appears the first immunization consisted of virus grown in culture for 14 days and was replication incompetent. The second immunization consisted of virus grown in culture for 13 days and demonstrated minimal replication capability. The third immunization consisted of virus grown in culture for 12 days and demonstrated replication capability that was impaired, but greater than that administered in the second series. This continued on for approximately 14 days. It appears Pasteur did not administer each vaccination compilation.

In one embodiment, an administration protocol for a vaccine based on psoralen inactivated HIV may include gradually ramping up the replication competence of the immunogen until administration of a live wild type virus to the vaccine as described above.

The serious consequences of administering a live non-attenuated HIV virus as a vaccine are known in the art. Therefore, in one embodiment an administration protocol for a vaccine based on psoralen inactivated HIV may be prophylactic. That is designed for HIV negative patients. In another embodiment, an administration protocol for a vaccine based on psoralen inactivated HIV may be therapeutic. That is designed for HIV positive patients.

Sample Protocol VIII:

Selection of Culture Material and Strain(s) of HIV Virus;

HIV live vectors may be purchased and used as sources of vaccine material from the various sources including but not limited to the national Institute of Health (NIH). These viral isolates lack many of the characteristics noted in actively infected patients since they have been passed through numerous cell lines in vitro. Quite typically, continuous cells lines (cells which have no finite end to the number of mitotic divisions possible) are used as a culture medium due to their universal availability, low cost, well defined nutrient needs and overall predictability.

The predictability of continuous cell cultures is defined by three parameters: 1) Infinite number of mitosis; 2) Short G1 phase of the cell cycle allowing cell division within hours or even minutes; and 3) Continual mutation. The virus, however, quickly adapts to the host environment. Continuous human T cell lines such as SupT1, H9, Jurkat or A3.01 can also be obtained from the NIH AIDS Research and Reference Reagent Program or the American Type Culture Collection, both in Rockville, Md. Laboratory adapted HIV viruses can propagate in these continuous cell lines but most viral isolates of human origin do not.¹¹ ¹¹Nelson Michael, et. al., 1999, HIV Protocols, Ch. 19, pp. 185-196

Classical virology distinguishes between “wild-type” virus and mutated or otherwise altered viral material. In actuality though a “wild-type” virus may not be and often is not synonymous with virus isolated from an intact host. Therefore, a distinction needs to be made between laboratory derived “wild-type” usually produced by passage through continuous cell cultures and viral isolates from the intact natural host. The latter are best referred to as field or clinical isolates and demonstrate the structural or genetic qualities that need to be mirrored in an appropriate vaccine.

Within an intact host the HIV virus inhabits multiple spheres, organ systems, histological tissues and is excreted in various cellular fluids in part or in whole. The actual HIV virus, as well as intact RNA and DNA sequences, can be recovered from infected patients at all stages of the disease spectrum even before the acute retroviral syndrome which occurs in most patients within 30 days of infection. As mentioned, the virus adapts to its host environment and with a half-life of six hours a typical HIV virus would be produced and secreted by cells in the same tissue that it ultimately re-infects. Therefore, viral cultures in different organ systems of the same patient often demonstrate subtle but important genotypic and phenotypic differences which are necessary for viral replication in the tissue it infects. This is an extrapolation on basic Darwinian principles that an organism will adapt to its environment or perish. The immunological milieu of the human host is divided into several separate biospheres or compartments (all of which become HIV infected) including but not limited to the gut associated lymphoid tissue (GALT), bronchial associated lymphoid tissue (BALT), skin associated lymphoid tissue (SALT), mammary associated lymphoid tissue (MALT) and conjunctival associated lymphoid tissue (CALT). The lymphocytes and other cellular as well as other molecular components of the immune system are not evenly distributed throughout the somatic tissues.¹² The immune pressure on the HIV virus, therefore, differs with its specific tissue or organ of origin. The genotypic and phenotypic expression of the virus will reflect the immune environment it propagates in. Genotypic and phenotypic differences of HIV have been observed in the same patient in different immune environments. The HIV cultured from transmission fluids would be the most logical starting source for virus isolation for vaccine manufacture. ¹²John A. Parrish, et. al., 1983, Photoimmunology, Chap. 6, pp. 95-130

The primary method of HIV transmission is sexual. Therefore the seminal, vaginal and rectal fluids would be the most logical point source for obtaining viral field or clinical isolates for vaccine production. Methods of specimen collection by cervicovaginal lavage are well defined. Manual collection of cervical secretions has also been delineated. This is an alternative method of obtaining either whole replication competent virions, viral RNA or DNA. Viral isolation from seminal fluid is also routinely performed.¹³ Methods of culturing HIV-1 in human semen are standard in the industry.¹⁴ Finally, the process of collection and processing of rectal secretions has been defined in the literature.¹⁵ ¹³Nelson Michael, et. al., 1999, HIV Protocols, Ch. 17, pp. 151-164¹⁴Nelson Michael, et. al., 1999, HIV Protocols, Ch. 8, pp. 51-57¹⁵Nelson Michael, et. al., 1999, HIV Protocols, Ch. 35, pp. 323-327

Detection, isolation and expansion of the HIV virus can be performed on a variety of infected tissues including, but not limited to, human monocytes/macrophages, T cells and central nervous system tissue.¹⁶ HIV culture and expansion can be accomplished with mitogen—stimulated peripheral blood mononuclear cells (PBMCs) from “normal” uninfected healthy donors.¹⁷ This process, although the cornerstone of many HIV vaccine and drug efforts, is perilous. The virus will continue to mutate in cell culture and will quickly assume genotypic and phenotypic characterizations (genetic drift) that differentiate it from the original tissue isolate. Cultures are also unreliable and often require 30 days before detectible viral replication is noted. ¹⁶Nelson Michael, et. al., 1999, HIV Protocols, Ch. 9 & 10, pp. 61-81¹⁷Nelson Michael, et. al., 1999, HIV Protocols, Ch. 1, pp. 3-10

Starting materials for isolation of viral nucleic acids can be divided into two broad categories: 1) cell rich; and 2) cell poor. Some overlap in these categories does exist. A cell poor isolate can be obtained from an initial cell rich culture. Cell rich starting materials include but are not limited to the following: 1) whole blood or blood fractions; 2) Bone marrow; 3) Tissue specimens, fresh, frozen, paraffin embedded or otherwise prepared; 4) In vitro cultured cells 5) Swabs impregnated with tissue derived fluids and cells; 6) Bronchial lavage; 7) Semen; and/or 8) Vaginal wall and cervical, uterine scrapings. Cell poor starting materials include but are not limited to the following: 1) blood plasma; 2) Blood serum; 3) Urine; 4) Saliva; 5) Cell culture supernatants; 6) Stool; 7) Seminal fluids; 8) Vaginal fluids.¹⁸ ¹⁸ Botho Bowien, et. al., 2003, Nucleic Acids Isolation Methods, Ch. 5, pp. 53-59

Viruses including HIV can be isolated from either category of startup materials. However, isolation of viral DNA from cell rich materials will be complicated by the co-purification of host and viral DNA. PCR based technology as discussed below can detect, isolate and amplify viral nucleic acid from cell rich cultures, but this requires a large amount of nucleic acid as template and this requirement may inhibit PCR.¹⁹ Viral DNA/RNA in cell rich medium is both cell associated and cell free. In the intracellular compartment viral nucleic acids may be integrated into the host genome or bound to host and/or viral proteins in both the cytoplasmic and nuclear compartments. Finally, nucleic acids in part or whole can be found in a cell rich system in the extracellular milieu protein free. Therefore, in a cell rich medium, the source and content of viral DNA is not uniform. ¹⁹Botho Bowien, et. al., 2003, Nucleic Acids Isolation Methods, Ch. 5, pp. 53-59

Cell free body fluids limit but do not completely eliminate host DNA contaminant. Viral DNA content in many cell poor isolates is characteristically of low titer necessitating concentration of nucleic acids before isolation and amplification.

Erythrocytes from mammals are enucleated shortly after entering the circulation and therefore have very little DNA. Mitochondrial DNA is still found within the mitochondria but in an intact cell containing a nucleus the mitochondrial DNA is a very small fraction of the total cellular DNA. Human blood contains approximately 1000 times more erythrocytes than leukocytes which have nuclei. Therefore, if blood is used as a selective medium for viral isolation and amplification the erythrocytes should be removed first. This can be accomplished by hypotonic shock since red blood cells burst more rapidly in a hypotonic medium than white blood cells. Ficoll-density-gradient centrifugation can separate mononuclear cells (lymphocytes and monocytes) from erythrocytes as well. Finally, centrifuging whole blood at 3300 g for ten minutes at room temperature separates the blood into three readily discernable fractions: (1) white blood cell enriched fraction known as the buffy coat. (2) Blood plasma. (3) Red blood cells.²⁰ The buffy coat would be a cell rich source suitable for viral nucleic acid separation and the blood plasma fraction would serve as a cell poor medium also suitable for viral nucleic acid separation. ²⁰Botho Bowien, et. al., 2003, Nucleic Acids Isolation Methods, Ch. 2, pp. 7-19

Selection of viral strains logically parallels those strains indigenous in the population. As mentioned above, a single clone of virus would not be representative of the HIV epidemic. Other factors to be considered include but are not limited to the immunogenicity and pathogenicity of individual HIV strains. Recently, HIV-1-M subtype C has emerged as a predominant strain in various areas of the globe. HIV-1 C is the most commonly transmitted subtype worldwide and predominates in Southern Africa, India, China and Brazil. This strain is more virulent and easier to transmit by sexual intercourse than other isolated strains. The 5′ LTR possesses three NF_(K)B binding sites and may in part or whole explain the enhanced virulence and ease of transmission of this strain. Other possible explanations for this subtype emerging as the leading strain of HIV worldwide include a prematurely truncated Rev protein, a 5-amino acid insertion into the Vpu protein and a more efficient protease enzyme. The HIV-1 C protease is distinct in primary, secondary, tertiary and quaternary structure. Specifically, the hinge region and the α-helix of HIV-1 C have been linked to increased protease activity. Finally, variation in the HIV-1 C protease specific cleavage sites has been linked to enhanced viral transmissibility and virulence.²¹ hu 21Tulio de Oliveira, et al., 2003, Variability at Human Immunodeficiency Virus Type 1 Subtype C Protease Cleavage Sites: an Indication of Viral Fitness?, Journal of Virology, pp. 9422-9430, September 2003.

In one embodiment, a vaccine may be comprised of the elements that most closely mirror the actual infectious particle or portion thereof. This should reflect the quasi-species genotypic and phenotypic variance noted in the intact host. The virions used for vaccine manufacture can come from any tissue source but seminal, vaginal and/or rectal tissue are targeted in one embodiment. Field or clinical isolates of the virus differ genotypically and phenotypically from isolates passed through in vitro cell cultures.

Without departing from the scope thereof, one skilled in the art can easily ascertain from the following descriptions, the essential characteristics of this invention to adapt it. The following descriptions and examples are set forth merely to illustrate the invention and are not intended to be limiting. Because modifications of the disclosed embodiments incorporating the spirit and substance of the invention may occur to persons skilled in the art, the invention should be construed to include everything within the scope of the appended claims and equivalents thereof. The patents, patent application publications and other publications referenced herein are incorporated in their entirety. 

1. A method of stimulating a Th-1 immune response to HIV-1 in a host mammalian subject, which method comprises: i) Administering to the host mammalian subject at least three doses of an immunogenic composition wherein the immunogenic composition comprises a whole inactivated HIV-1 virus, wherein the virus has been inactivated by exposure to ultraviolet radiation and psoralen, lacks CD55 and CD59 in the viral membrane and has been subjected to desialation, and wherein the time between administration of the first and second doses of the immunogenic composition is from 1 to 20 days and the time between administration of the second and third doses is from 120 to 180 days; further wherein each dose of the immunogenic composition is a ten fold dilution in concentration of the previous dose; and ii) Administering to the host mammalian subject an adjuvant to boost the Th-1 immune response, wherein the time between the first and second administration of the adjuvant is from 1 to 20 days and the time between the second and third administration is from 120 to 180 days.
 2. A method according to claim 1, wherein the starting dose of the inactivated HIV virus is 1×10⁹-1×10¹⁰.
 3. A method according to claim 1, wherein the adjuvant is a leukotriene receptor antagonist.
 4. A method according to claim 2, wherein the leukotriene receptor antagonist is Montelukast.
 5. A method according to claim 1, wherein the adjuvant is a mast cell and basophil stabilizer.
 6. A method according to claim 5, wherein the mast cell and basophil stabilizer is Cromolyn.
 7. A method according to claim 1, wherein the adjuvant is a prostaglandin synthetase inhibitor.
 8. A method according to claim 1, wherein the prostaglandin synthetase inhibitor is Indomethacin.
 9. A method according to claim 1, wherein the site of administration of the immunogenic composition is one that targets lymphatic tissue.
 10. A method according to claim 1, wherein the administering to the host mammalian subject at least three doses of an immunogenic composition is repeated until a Th-1 immune response is detected.
 11. A method according to claim 1, wherein the immunogenic composition is administered, by capsule, gelcap, tablet, enteric capsule, encapsulated particle, powder, suppository, injection, ointment, cream, implant, patch, liquid, inhalant, or spray.
 12. A method according to claim 1, wherein the immunogenic composition is administered, orally, transbucally, transmucosally, sublingually, nasally, rectally, vaginally, intraocularly, intramuscularly, intralymphatically, intravenously, subcutaneously, transdermally, intradermally, intra tumor, topically, transpulmonarily, by inhalation, by injection, or by implantation. 